tbuckley/cabot-search huggingface dataset:
National, State-Level, and County-Level Prevalence Estimates of Adults Aged ≥18 Years Self-Reporting a Lifetime Diagnosis of Depression — United States, 2020
Authors: Benjamin Lee, Yan Wang, Susan A. Carlson, Kurt J. Greenlund, Hua Lu, Yong Liu, Janet B. Croft, Paul I. Eke, Machell Town, Craig W. Thomas
Journal: MMWR Morbidity and Mortality Weekly Report (2023)

Depression is a major contributor to mortality, morbidity, disability, and economic costs in the United States (1). Examining the geographic distribution of depression at the state and county levels can help guide state- and local-level efforts to prevent, treat, and manage depression. CDC analyzed 2020 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate the national, state-level, and county-level prevalence of U.S. adults aged ≥18 years self-reporting a lifetime diagnosis of depression (referred to as depression). During 2020, the age-standardized prevalence of depression among adults was 18.5%. Among states, the age-standardized prevalence of depression ranged from 12.7% to 27.5% (median = 19.9%); most of the states with the highest prevalence were in the Appalachian* and southern Mississippi Valley† regions. Among 3,143 counties, the model-based age-standardized prevalence of depression ranged from 10.7% to 31.9% (median = 21.8%); most of the counties with the highest prevalence were in the Appalachian region, the southern Mississippi Valley region, and Missouri, Oklahoma, and Washington. These data can help decision-makers prioritize health planning and interventions in areas with the largest gaps or inequities, which could include implementation of evidence-based interventions and practices such as those recommended by The Guide to Community Preventive Services Task Force (CPSTF) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
Abstract 240: High First Shock Success With Reduction In Refractory Ventricular Fibrillation In A Real-world Public Access Defibrillator Registry Of Out-of-hospital Cardiac Arrests
Authors: Amy Kernaghan, Adam Harvey, Olibhear McAlister, Hannah Torney, David McEneaney, Jennifer Adgey
Journal: Circulation (2022)

Introduction: Refractory VF, which is defined as fibrillation that persists after three or more shocks, has been reported to occur in 20% of VF presenting cardiac arrest patients. This analysis was conducted to assess the frequency of shock resistant VF, during OHCA treated with a public access defibrillator (PAD). Methods: Heartsine Samaritan PAD post-market data collected between October 2012 to January 2021 were analyzed; electrocardiography (ECG) is recorded by the PAD and is assessed for shockability immediately after detecting patient impedance and then following each 2-minute period of CPR. Shock success (SS) was determined for each shock. SS was defined as one in which the initial shockable arrhythmia was terminated for at least five seconds. A consecutive shock was defined as a shock delivered after the first analysis mode following a previous shock. Results: Data was analyzed for 1082 patients who received at least one shock during OHCA. First shock success (FSS) was 88.2% (862/977 assessable shocks). At least three consecutive shocks were delivered in 207/1082 (19.1%) patients. Three patients (3/207, 1.4%) had two unsuccessful shocks followed by termination of VF on the third shock. A further thirteen (13/204, 6.4%) patients had VF which was resistant to defibrillation (i.e., three or more consecutive failed shocks with no observed successful shock). In the remaining 191 patients at least one of the three consecutive shocks was successful, or shock success could not be determined. Conclusion: The prevalence of shock resistant VF for OHCA treated with a PAD is much lower (6.4%) than published data. This low prevalence is in part due to the high FSS observed resulting in reduction in the number of possible shock resistant cases.
Abstract 187: Synergy Of Elevation Of The Head And Thorax And Resuscitative Endovascular Balloon Occlusion Of The Aorta In A Porcine Model Of Prolonged Cardiac Arrest: A Pilot Study
Authors: Johanna C Moore, Bayert Salverda, Michael Lick, Susana Arango, Mithun Suresh, Anja Metzger, Keith G Lurie, Michael Johnson
Journal: Circulation (2022)

Background: Two new approaches to improve cardiac arrest outcomes, active compression-decompression (ACD) with an impedance threshold device (ITD) CPR with automated Head Up Positioning, (AHUP-CPR), and resuscitative endovascular balloon occlusion (REBOA) have been studied separately but never together. This was a pilot animal study exploring potential hemodynamic synergy of AHUP+ REBOA after prolonged CPR. Methods: Farm pigs (~40 kg) were sedated, intubated, and anesthetized. Central venous, and intracranial pressures were measured. Bilateral femoral arterial access was obtained for arterial pressure measurement and REBOA placement in the proximal thoracic aorta. Hemodynamics were measured with solid state pressure catheters. The arterial pressure catheter was placed in the thoracic aorta and confirmed via fluoroscopy. After 35 minutes of AHUP CPR, animals underwent two-minute epochs of AHUP-CPR, AHUP+REBOA CPR, ACD+ITD CPR flat + REBOA, and ACD+ITD CPR flat. Pressures are reported as mean (mmHg) ± standard deviation. Comparison testing was not performed in this pilot study. Results: In 4 pigs after 35 minutes, the AHUP CPR cerebral perfusion pressure (CerPP) was 21.1 ± 10.4, aortic compression (AOC) and decompression (AOD) pressures were 43.4 ± 9.1 and 14.1 ± 9.4, and intracranial compression (ICP) and decompression (DIP) pressures were 9.2 ± 2.7 and 6.5 ± 3.6, respectively. With AHUP+REBOA, CerPP was 39.0 ± 8.7, AOC and AOD pressures were 69.2 ± 10.7 and 21.0 ± 8.9, and ICP and DIP 9.7 ± 2.6 and 5.8 ± 2.9. The ACD+ITD CPR flat + REBOA CerPP was 21.7 ± 11.8, AOC and AOD pressures were 57.1 ± 9.5, and ICP and DIP were 20.5 ± 4.1 and 15.9 ± 3.2. The ACD+ITD CPR flat CerPP was 11.2 ± 7.5, AOC and AOD pressures were 38.8 ± 6.7 and 15.9 ± 6.6, and ICP and DIB were 17.4 ± 1.1 and 15.0 ± 1.6. A representative study tracing is shown. Conclusions: The combination of AHUP CPR with REBOA is feasible and may work synergistically after prolonged resuscitation in this ongoing animal study.
Abstract 15830: Pharmacological Inhibition of Lysophosphatidic Acid Reduces Inflammation and Enhances Myocardial Recovery After Acute Infarction in Diet-Induced Obese Mice
Authors: Himi Tripathi, Renee R Donahue, Erhe Gao, Bryana Levitan, Ahmed Abdel-Latif
Journal: Circulation (2022)

Introduction: Obesity is approaching epidemic status in the United States and is strongly associated with a higher risk of heart failure after myocardial infarction (MI), a major cause of morbidity and mortality in obese individuals. However, the mechanisms underlying obesity-associated heart failure are poorly understood. Lysophosphatidic acid (LPA), produced by autotaxin (ATX), is highly expressed in adipose tissue with increased levels in obesity and has been shown to mediate post-MI inflammation. Methods: 3-week aged male C57BL/6J mice were randomly assigned to low-fat (LFD-10%) or high-fat (HFD-60%) diet based on the percentage of calories from fat. HFD-fed mice were randomly assigned to receive the specific ATX inhibitor, PF-8380 at 10 mg/kg twice daily. 2 months after initiating the diet, mice were randomized to undergo MI surgery (permanent ligation of the left anterior descending artery) or sham surgery. Results: MI was associated with an increased number of circulating inflammatory monocytes (CD45 + /Ly6C + /CD115 + ), as well as cardiac total and pro-inflammatory macrophages (CD45 + /F4-80 + /CD11b + /CD86 + ), as assessed by flow cytometry (Fig. 1A). This effect was exacerbated in HFD-fed mice but significantly attenuated in HFD+PF8380 treated mice with effective ATX inhibition. Changes in circulating and cardiac immune cells were reflective of increased proliferation of bone marrow progenitors, a phenomenon that was blunted by ATX inhibition (Fig. 1B). Moreover, HFD was associated with larger scar size (Fig. 1C) and worse cardiac functional recovery (Fig. 1D) 30 days after MI. The obesity-asscoiated heart failure could be rescued by ATX inhibition. Conclusion: ATX/LPA plays an important role in modulating inflammation and could be a therapeutic target for obesity-related coronary heart diseases.
Abstract 15617: Severe Heart Failure: Fistulous Connection Between Ectatic Left Anterior Descending Artery, Coronary Sinus, and Left Ventricular Cavity
Authors: Aditya Patel, Ruhma Ali, Hardik Fichadiya, Asrar Ahmad, Ahsan Khan, Addi Suleiman
Journal: Circulation (2022)

Introduction: Arteriovenous coronary fistula of LAD to the coronary sinus is a rare vascular anomaly present in 0.002% of the general population. We report a rare case of fistulous connection between exceptionally large LAD and coronary sinus into the LV cavity leading to severe systolic heart failure. Case: A 39-year-old male with no past medical history presented to the ED with complaints of dyspnea, chest pain and lower extremity edema for the past 3 months. The chest pain was substernal, squeezing, non-radiating, 2/10 in intensity, exacerbated by exertion and alleviated with rest. The patient did not have any cardiology work up in the past. Vitals were stable. The patient had irregular rhythm with prominent JVD and bilateral lower extremity edema on examination. Troponins were negative, BNP was elevated and thyroid function was normal. Chest x-ray showed cardiomegaly. EKG showed atrial fibrillation with no significant ST segment changes or Q waves. Echocardiogram showed severe systolic left ventricular dysfunction with an ejection fraction of 15-20% and moderate to severe secondary mitral regurgitation. Cardiac catheterization showed large ectatic LAD with mild stenosis in mid segment. An abnormal connection was noted between LAD and coronary sinus draining directly into the left ventricle. He was discharged on guideline directed medical therapy for heart failure. Discussion: Fistula between LAD, coronary sinus and LV cavity is a unique organic heart disease. Our patient presented with heart failure with no apparent identifiable cause. On angiography an ectatic LAD was connected to the coronary sinus and LV cavity which created a high output state on the LV. The management of this rare pathology is complex due to variable presentation and lack of specific treatment guidelines. Careful selection of certain cases for therapeutic intervention can result in better outcomes than medical therapy alone.
Abstract 15516: A Nationally Representative Evaluation of Patients With Established Cardiovascular Disease and Cardiovascular Risk Factors Achieving Health Goals With Electronic Devices in the United States
Authors: Arya Aminorroaya, Lovedeep S Dhingra, Evangelos Oikonomou, Arash Aghajani Nargesi, Rohan Khera
Journal: Circulation (2022)

Background: Electronic devices, like tablets and smartphones, may help users track and manage cardiovascular (CV) risk factors. However, data on their effectiveness and equitable distribution are scarce. We aimed to investigate the patterns and predictors of achieving health goals using tablets/smartphones among patients with CVD or with CV risk factors. Methods: We used data from the nationally representative Health Information National Trends Survey 5 (HINTS5) from 2017 to 2020. In a validated questionnaire, tracking a health-related goal (quitting smoking, losing weight, or increasing physical activity) using tablets/smartphones was assessed in patients with CVD (ischemic heart disease and congestive heart failure) or CV risk factors (smoking, obesity, hypertension, and diabetes), for magnitude and demographic predictors of success. Results: Among 16,092 participants of HINTS5, 1,606 had CVD (68±14 years, 47% women), and 8,984 were at risk of CVD (59±15 years, 59% women). During 2017-2020, compared with an estimated 46% (95% CI: 44-47%) of the US adult population, 33% (95% CI: 28-38%) of patients with CVD and 43% (95%CI: 41-45%) of patients at-risk of CVD successfully reported tracking their progress to achieve a CV health goal using tablets/smartphones. Younger age, female sex, non-Hispanic Black race, and higher income were significantly associated with higher proportion reporting improving their CV health, among patients with and at-risk of CVD. Discussion: Nearly half of patients with CV risk factors successfully manage health habits using electronic devices, but given large underuse among demographic groups with frequent adverse cardiovascular outcomes, a systematic approach to their use in clinical care may help improve patient outcomes.
Abstract 15867: A Swimming Heart: A Unique Complication of Gastropericardial Fistula
Authors: Carlos Requena Armas, Juan Del Cid Fratti, sudhir mungee
Journal: Circulation (2022)

Background: Gastropericardial fistula is a rare clinical entity associated with gastroesophageal operations. Case: 63-year-old female with medical history of hypertension, GERD, and hiatal hernia status post Nissen fundoplication presented to the ER with one week of chest pain and dyspnea. Six months prior to presentation, she was found with ischemic colitis, candida esophagitis and slipped Nissen. In the ER, she was febrile and hypoxic. Chest x-ray showed a large hydropneumopericardium with air-fluid level. CT chest showed pneumomediastinum. Upon arrival to our facility, an echocardiogram showed normal EF 65% and a large complex pericardial effusion with presence of gas, liquid, and organized material without evidence of tamponade. Repeat CT abdomen showed a thin-walled collection of gas and fluid projecting from the area of the Nissen through the diaphragmatic hiatus in contact with the pericardium suspicious for a gastropericardial fistula. She went to the OR for pericardial window with drainage of 700 cc of purulent fluid and findings of chronic-appearing granulation of the pericardium. Intraoperative endoscopy noted a perforation near the GE junction that was stented with a 155 x 23 mm covered esophageal stent. Cultures grew Candida and gramnegative bacilli. She then underwent staged right thoracotomy with repair of fistula with intercostal muscle flap. Postoperative course was complicated with posterior wall hemorrhage requiring embolization of the left eight intercostal artery. The esophageal stent was removed three months post insertion due to distal migration causing superficial ulceration and esophagitis. Patient has since recovered gradually without further complications. Discussion: Gastropericardial fistula is associated with high morbidity and mortality. The treatment is surgical with early pericardial drainage usually by pericardial window and de-functioning esophagostomy or gastrostomy plus repair of the defect.
Abstract 15532: Pressure Measurement From a Peripheral Iv Correlates Well With Invasive Central Venous Pressure Measurement
Authors: Max Ruge, Ashley Traczuk, Nicholas J Ruggiero, Gregory Gibson, Indranee Rajapreyar, Yevgeniy Brailovsky, Mahek Shah
Journal: Circulation (2022)

Introduction: Despite its importance in cardiac patients, accurate central venous pressure (CVP) estimation remains a challenge. Noninvasive methods, such as jugular venous pressure measurement, are highly dependent on examiner experience, and the gold-standard invasive methods require procedures that carry risk of complication. Recent studies suggest that pressure measurement directly from a patient’s peripheral intravenous (IV) catheter, termed peripheral venous pressure (PVP), appears promising as an accurate and noninvasive method for CVP estimation. Methods: To be included in the study, patients were either receiving right heart catheterization (RHC) or had an existing pulmonary artery catheter (PAC) in place. CVP was measured using standard technique either during RHC or at bedside from the PAC. The same pressure tubing was then connecting to the patient’s existing IV, regardless of the location or catheter gauge, for measurement of the PVP. Results: Seventeen patients were prospectively enrolled. The majority (70.6%) had their CVP and PVP measured during RHC. In the overall cohort, 35.3% were on mechanical circulatory support, and 29.4% were on inotropes at the time of measurement. CVP and PVP measurements were significantly correlated with one another (Pearson’s r = 0.73, p &lt; 0.001; Figure 1A). Sensitivity analysis was performed to exclude one notable outlier, which strengthened the correlation (Pearson’s r = 0.91, p &lt; 0.001; Figure 1B). Conclusions: This data suggests that PVP is a promising and simple method for the noninvasive estimation of CVP.
Abstract 15782: A Rare Case of Septal Atrial Flutter
Authors: Zeba Hashmath, Aditi Naniwadekar
Journal: Circulation (2022)

Background: Isthmus-dependent counterclockwise or clockwise flutter is well defined and responsive to radiofrequency ablation (RFA) of the cavotricuspidisthmus (CTI). However, inter-atrial septal (IAS) flutter is rare and occurs with IAS substrate abnormalities and prior cardiac surgery. Case: A 62-year-old female with paroxysmal AF on rivaroxaban, hypertension and diabetes mellitus presented with palpitations refractory to propafenone and metoprolol. She underwent successful isolation of all four pulmonary veins (PVs) and RFA of the CTI with demonstration of bidirectional block. A year later, she presented with atypical AFL (Fig 1A) failing cardioversion. During redo ablation, bipolar voltage map of the left atrium (LA) demonstrated durable isolation of all four PVs. Burst pacing (BP) from the coronary sinus (CS) up to 220ms did not induce AFL. The LA posterior box was isolated by creating a roof line and a line connecting the inferior veins (Fig 1B). No extra-PV triggers were noted on high dose isoproterenol. However, during the washout period, BP from the CS induced AFL with a tachycardia cycle length of 237ms, concentric CS activation and almost simultaneous activation along the crista in the right atrium (RA). High-density activation and coherent mapping of LA and RA suggested a micro-reentrant circuit over the posterior IAS with wavefront collision across the CTI (Fig 1C, D). Concealed entrainment was observed over the LA posterior septum near the transseptal puncture site. RFA successfully terminated the AFL. RFA was performed in a sequential unipolar fashion on both sides of the septum over areas of fractionation. No atrial arrhythmias were inducible with BP on or off isoproterenol. Patient remained in sinus rhythm at 9 month follow up. Conclusion: IAS flutter post AF ablation or cardiac surgery is rare, and management is challenging. While RFA has a 93% success rate, larger studies are required to further delineate this condition.
Abstract 15720: Single Cell Spatial Transcriptomics of the Ischemic Borderzone
Authors: David Calcagno, Nika Taghdiri, Van K Ninh, Zhenxing Fu, Kevin R King
Journal: Circulation (2022)

Introduction: Myocardial infarction (MI), leads to development of an infarct borderzone (BZ) separating areas of cell death (ischemic zones, IZ) from surviving myocardium (remote zones, RZ). The BZ is a geographically complex and biologically enigmatic territory thought to play critical roles in infarct expansion, ventricular remodeling, arrhythmias, and provisional regeneration; however, its cellular and molecular processes are not well understood because previous studies have relied on microdissection, which combines zones in uncontrolled and unmeasured proportions. Hypothesis: We hypothesize that the BZ can be redefined using single cell spatial transcriptomics. Methods: We used single cell and single nuclei RNA-seq, capture-based spatial transcriptomics, and multiplexed RNA fluorescence in situ hybridization (mFISH) to redefine the BZ into functional subunits. Results: Transcriptomic data from more than 300,000 cells reveal that the BZ is comprised of multiple spatially defined niches characterized by distinct structural, morphological, transcriptional, and functional subsets of cardiomyocytes, fibroblasts, monocytes/macrophages, and neutrophils. We identified two distinct BZ populations of cardiomyocytes (CMs): BZ1 (Nppa+Xirp2-), which forms a hundreds-of-microns-thick transitional layer adjacent to the RZ, and BZ2 (Nppa+Xirp2+), which forms a tens-of-microns-thick layer that decorates the complex peninsulas and islands adjacent to the dead myocardium of the IZ. Compared to BZ1 CMs, BZ2 CMs have significantly reduced contact area with neighboring CMs; express elevated levels of genes involved in mechanotransduction; and preferentially colocalize with matricellular-protein-expressing myofibroblasts. The transcriptional BZ is detectable within an hour of ischemia, prior to immune infiltration or fibroblast activation. We propose a unifying "loss of neighbor" hypothesis to mechanistically explain the results. Conclusions: Our work demonstrates that harmonizing multi-modality single cell and spatially resolved datasets has the potential to uncover new biology in the ischemic borderzone.
Abstract 191: Alcohol Consumption Before Injury Did Not Improve Neurological Outcomes In Patients With Severe Traumatic Brain Injury: A Nationwide, Retrospective Cohort Study
Authors: Tsuyoshi Nojima, Hiromichi Naito, Takashi Hongo, Takafumi Obara, Hirotsugu Yamamoto, Tetsuya Yumoto, Kohei Tsukahara, Atsunori Nakao
Journal: Circulation (2022)

Introduction: Traumatic brain injury (TBI) is a major global public health concern. Notably, alcohol may confer neuroprotective effects by inhibiting of N-methyl-D-aspartate receptors; however, the impact of alcohol exposure before injury on neurological outcomes in patients with TBI has not been well studied. Hypothesis: We evaluated whether alcohol consumption before injury was associated with favorable neurological outcomes in patients with severe TBI using a large, national trauma registry. Methods: This study was a retrospective analysis of data collected into the Japan Trauma Data Bank from 2017 to 2021. Patients over 20 years old with severe TBI, defined as head Abbreviated Injury Scale score of 4 or 5, were included. We excluded patients with unknown alcohol status or outcomes. Subjects were divided into two groups (alcohol group vs. non-alcohol group) based on whether or not they were exposed to alcohol before injury. The primary outcome was favorable neurological outcomes (Glasgow Outcome Scale score of 4 or 5) at hospital discharge. A multivariate logistic regression analysis was conducted to adjust potential cofounders including age, sex, injury severity, emergency treatment, and emergency transfusion. Results: A total of 1,482 patients were included, with a median age of 73 years old; 381 of the patients were women. Median Injury Severity Score was 24. Of the 1,482 patients, 284 were in the alcohol group and 1,208 were in the non-alcohol group. Favorable neurological outcomes were observed in 159 (56%) and 563 (47%) of patients, with median hospital length of stay of 21 days and 18 days in the alcohol group and non-alcohol group, respectively. Multivariate logistic regression analysis showed alcohol consumption before injury was not associated with favorable neurological outcomes (adjusted OR: 0.96, 95% CI: 0.72 - 1.29). Conclusions: Alcohol consumption before injury had no positive impact on neurological outcomes in patients with severe TBI.